Heterotopic Pregnancies

A Rare Occurrence Until Now

Heterotopic or heterotropic pregnancy is rare, but the incidents of it are on the rise. Heterotopic pregnancy is a multiple pregnancy with one embryo viably implanted in the uterus and the other implanted elsewhere as an ectopic pregnancy. This type of pregnancy does occur very rarely in natural conception, at the rate of 1 in 30,000. However, in pregnancies conceived through assisted reproduction, the rate of heterotopic pregnancies jumps to as many as 1 in 100 pregnancies.

Today's rate of heterotopic pregnancies has increased dramatically partly due to a rise in pelvic inflammatory disease (PID), and partly due to a number of other issues. Previous pelvic surgery, congenital or acquired abnormalities of the uterine cavity and fallopian tubes may contribute to the condition, as does tubal microsurgery, drug ovulation stimulation, and ART.

When it comes to women who have undergone IVF (in vitro fertilization), the rise in occurrence is largely due to the transfer of multiple embryos to the uterus. Research indicates that when more than five embryos are implanted, the risk of heterotopic pregnancy increases from 1 in 100 to 1 in 45.

Difficult to Diagnose

A heterotopic pregnancy is very difficult to diagnose. Nearly 85 percent of them go undiagnosed until there is a rupture of the ectopic pregnancy that accompanies the intrauterine pregnancy. Once an intrauterine pregnancy is identified by ultrasound, the ectopic pregnancy, in about 50 percent of cases, is spotted within two weeks of the identification. One of the most frequently used methods of discovering an ectopic pregnancy combined with an intrauterine pregnancy is the monitoring of beta hCG in the blood coupled with transvaginal ultrasound. The difficulty in relying upon the blood tests is that since there is a normal pregnancy, the blood evaluations are not always indicative of the ectopic pregnancy.

Once Diagnosed, Treatment Is Not Easy, Either

There are many variables in heterotopic pregnancy so discovering the ectopic pregnancy is very challenging. Once it has been diagnosed, treatment of an ectopic pregnancy in a heterotopic pregnancy requires careful consideration of the viability of the uterine pregnancy. Much depends upon the state of the woman and the skill of the doctor should surgery be the course of treatment.

Laparoscopy is the ideal surgical method to remove an ectopic pregnancy before it ruptures without interrupting the viable pregnancy. Although the intrauterine pregnancy can still survive if the ectopic pregnancy ruptures, there is an increased danger of miscarriage. The surgery must be done with great skill and it is important that bleeding be addressed quickly. Medical therapies include injecting the ectopic pregnancy in order to terminate the gestation. However, there are potential dangers inherent in such procedures, including harm to the viable pregnancy and long-term impairment of tubal function afterward.

There Is Hope

Surgery remains the option of choice when it comes to treating a heterotopic pregnancy. Early diagnosis is the key to success in both treatment and delivery. The risks are great for miscarriage, especially in the first trimester. However, with the rise in cases of heterotopic pregnancies, the need for answers has become more demanding and reproduction specialists are focusing more on solutions.


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